Insulin Level Patterns with Chemotherapy and Intermittent Enteral Feeding Options

2.50
Hdl Handle:
http://hdl.handle.net/10755/149178
Type:
Presentation
Title:
Insulin Level Patterns with Chemotherapy and Intermittent Enteral Feeding Options
Abstract:
Insulin Level Patterns with Chemotherapy and Intermittent Enteral Feeding Options
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Westfall, Una, PhD
P.I. Institution Name:Oregon Health & Science University
Title:Professor
Objective: Adequate nutrition is a major challenge for many cancer patients. When nutrition can’t be taken orally but the gut is intact, enteral feedings can be a nourishment option. To add to the knowledge base nurses use to make enteral nutrition decisions, this study tested for the presence and characteristics of systemic insulin with 12 hour [rest-time] enteral feedings by two feeding methods using a high- or no-fiber formula at two calorie levels in the presence of the chemotherapetic agent, 5-fluorouracil (5-FU). Design: Experimental 2x2x2 randomized block design; rats were in 1 of 8 feeding groups, with 5/cell. Sample: Forty Sprague-Dawley male, adult rats who received intraperitoneal (IP) 5-FU were randomly assigned to feeding groups. Hourly bloods were drawn over 24 hours for each feeding group. Setting: Rats were in a single room with a 12hr on:12hr off light cycle at an approved animal facility. Variables: Central to this study were the delivery method (infusion vs. bolus) and high-(3.4gms/240ml) vs. no-fiber (0.0gms/240ml) formula. Another independent variable was calorie level (80 [ample] vs. 55kcals [restricted]). The dependent variable was hourly serum insulin levels (uU/ml). Measures/Instruments: All rats participated in a standard 28-day protocol with gastrostomy tubes placed when body weights were = 170 gms (~ Day 7). After environmental and feeding acclimation, enteral feedings were delivered Days 18-28. IP 5-FU, 50mg/kg, was given Day 22. Blood samples were collected the last 2 protocol days. Serum samples were used to construct a composite animal for each feeding group. Duplicate samples for insulin 125 I assays had CV= <3.0%. Values were in uU/ml. Findings: In all 8 groups, there was less hour-to-hour serum insulin variability with infusion compared with bolus feedings (Infusion spAN: 11.1-26.3uU/ml; Bolus spAN: 40.5-210.2uU/ml). With a high-fiber level and maximum formula bolus volume, hour-to-hour serum insulin levels ranged from 8.0-94uU/ml; with no-fiber formula and restricted bolus volume, the hour-to-hour levels ranged from 9.8 to 222uU/ml. Graphs follow from the two 55calorie bolus groups--alike except for fiber content. Bolus enteral feedings were at 6 am, 10 am, 2 pm(1400 hr), and 6 pm(1800 hr). Conclusions: By far the greatest hourly differences were found in the no-fiber group receiving 55 Kcal by bolus delivery. The hourly differences were greatest during early bolus feeding times. Little fluctuation was present with the last feeding of the day, delivered at the beginning of activity time. With ample formula by bolus, greater hour-to-hour variability was present in the high-fiber formula group. This differs from the pattern found in healthy rats, where there was a consistent pattern of greater fluctuations in those animals receiving no-fiber formula by bolus, regardless of kcal level. Implications: These findings suggest that if vulnerable groups receiving 5-FU and enteral feedings are unable to mount or accommodate to rapid and wide fluctuations in blood insulin levels, some enteral feeding options, such as bolus delivery over limited time periods, may be detrimental. In our groups receiving 5 FU, fiber content produced different responses dependent on the calorie level.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleInsulin Level Patterns with Chemotherapy and Intermittent Enteral Feeding Optionsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/149178-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Insulin Level Patterns with Chemotherapy and Intermittent Enteral Feeding Options</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Westfall, Una, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Oregon Health &amp; Science University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">westfall@ohsu.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: Adequate nutrition is a major challenge for many cancer patients. When nutrition can&rsquo;t be taken orally but the gut is intact, enteral feedings can be a nourishment option. To add to the knowledge base nurses use to make enteral nutrition decisions, this study tested for the presence and characteristics of systemic insulin with 12 hour [rest-time] enteral feedings by two feeding methods using a high- or no-fiber formula at two calorie levels in the presence of the chemotherapetic agent, 5-fluorouracil (5-FU). Design: Experimental 2x2x2 randomized block design; rats were in 1 of 8 feeding groups, with 5/cell. Sample: Forty Sprague-Dawley male, adult rats who received intraperitoneal (IP) 5-FU were randomly assigned to feeding groups. Hourly bloods were drawn over 24 hours for each feeding group. Setting: Rats were in a single room with a 12hr on:12hr off light cycle at an approved animal facility. Variables: Central to this study were the delivery method (infusion vs. bolus) and high-(3.4gms/240ml) vs. no-fiber (0.0gms/240ml) formula. Another independent variable was calorie level (80 [ample] vs. 55kcals [restricted]). The dependent variable was hourly serum insulin levels (uU/ml). Measures/Instruments: All rats participated in a standard 28-day protocol with gastrostomy tubes placed when body weights were = 170 gms (~ Day 7). After environmental and feeding acclimation, enteral feedings were delivered Days 18-28. IP 5-FU, 50mg/kg, was given Day 22. Blood samples were collected the last 2 protocol days. Serum samples were used to construct a composite animal for each feeding group. Duplicate samples for insulin 125 I assays had CV= &lt;3.0%. Values were in uU/ml. Findings: In all 8 groups, there was less hour-to-hour serum insulin variability with infusion compared with bolus feedings (Infusion spAN: 11.1-26.3uU/ml; Bolus spAN: 40.5-210.2uU/ml). With a high-fiber level and maximum formula bolus volume, hour-to-hour serum insulin levels ranged from 8.0-94uU/ml; with no-fiber formula and restricted bolus volume, the hour-to-hour levels ranged from 9.8 to 222uU/ml. Graphs follow from the two 55calorie bolus groups--alike except for fiber content. Bolus enteral feedings were at 6 am, 10 am, 2 pm(1400 hr), and 6 pm(1800 hr). Conclusions: By far the greatest hourly differences were found in the no-fiber group receiving 55 Kcal by bolus delivery. The hourly differences were greatest during early bolus feeding times. Little fluctuation was present with the last feeding of the day, delivered at the beginning of activity time. With ample formula by bolus, greater hour-to-hour variability was present in the high-fiber formula group. This differs from the pattern found in healthy rats, where there was a consistent pattern of greater fluctuations in those animals receiving no-fiber formula by bolus, regardless of kcal level. Implications: These findings suggest that if vulnerable groups receiving 5-FU and enteral feedings are unable to mount or accommodate to rapid and wide fluctuations in blood insulin levels, some enteral feeding options, such as bolus delivery over limited time periods, may be detrimental. In our groups receiving 5 FU, fiber content produced different responses dependent on the calorie level.</td></tr></table>en_GB
dc.date.available2011-10-26T09:57:32Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:57:32Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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